THE ASSESSMENT OF RISK MANAGEMENT IN HEALTHCARE SERVICE IN NIGERIA
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CHAPTER ONE
INTRODUCTION
1.1 Background to the study
In recent years, healthcare systems have undergone a variety of changes, ranging from technical to normative, all of which call for better efficiency. Furthermore, biomedical advancements in recent decades have contributed to an increase in organizational complexity in hospitals, which is caused by a variety of factors such as multiple professional experiences, non-uniform management models, patient specificity, surgery complexity, reduced inpatient days, and an increasing number of healthcare service users due to an increase in average lifespan.
As a result of scientific and technological advancements, the complexity of medicine necessitates the development of new management models (Bridges 2006). Thus, this setting emphasizes the importance of developing systemic methodologies capable of detecting waste and errors and proposing organizational and/or technology solutions for continuous development.
To that end, following the success of applying Kaizen principles to the manufacturing sector (Liker, 2004; Liker and Hoseus, 2008), international healthcare organizations such as The Joint Commission on Accreditation of Healthcare Organizations and The World Health Organization created and adopted the concept of clinical governance. Clinical governance seeks to ensure that patients receive the highest quality of care. It comprises systems and processes for monitoring and improving services, risk management, clinical auditing, clinical effectiveness programs, staff management, education training, and ongoing personal development, as well as the use of information to enhance healthcare delivery (Sale, 2005).
Risk management is one of the most important parts of clinical governance since it handles clinical risks that affect patients. The literature demonstrates that clinical risk management does not usually take a systemic approach. Furthermore, it frequently does not rely on people’s understanding of the examined processes, nor does it provide useful support for decision making.
The well-being of healthcare personnel is critical to the ongoing delivery of health care. The nature of their employment exposes healthcare workers to risks. Due to a lack of adequate risk management, healthcare personnel have become victims of limited safety resources, poor maintenance, low safety awareness, and other issues (Nwachukwu et al., 2020).
These factors may have contributed to the high rate of employee injuries, fatalities, and near-misses. Healthcare workers face risks such as ion radiation, stress, injury, pathogenic chemicals, and poisons as a result of their work (Innocent et al., 2022). Complications, high morbidity rates, medical errors, and other issues are common in healthcare settings, particularly in Nigeria. However, risk management is a relatively new idea in Nigerian healthcare companies compared to affluent countries (Abor and Abor, 2021).
Risk management is the process of recognizing, managing, and mitigating the consequences of unknown events (Spross et al., 2017). It is the identification, assessment, and ranking of risks, accompanied by the organized, systematic allocation of resources to minimize, track, and mitigate the possibility and impact of unwanted events or to increase understanding of opportunities. (Frempong et al. 2019).
In healthcare, risk management refers to the medical and organizational processes used to analyze, recognize, and reduce the risk of injury to patients, hospital personnel, and third parties, as well as the risk of loss to the business. Clinical risk management (CRM) refers to the tools, structures, procedures, and practices used to identify, evaluate, avoid, monitor, and manage healthcare risks. The goal of risk management is to keep patients, hospital staff, and visitors safe. (Abor and Abor, 2021; Gbadago et al., 2017). Nurses play a critical role in risk management by defining and executing safety standards to protect both patients and healthcare personnel.
Risk management is critical in the healthcare sector, and adhering to international risk management standards, such as ISO 31000, entails several critical stages, including risk identification, analysis, evaluation, treatment, and review, all of which require consultation and communication (Tasneem et al., 2018; Spross et al., 2017). In health care, risk management (R.M.) refers to a system of numerous techniques used to estimate, assess, and prevent risk in order to reduce the chance of negative consequences on a number of parameters, including technical and economic aspects (Alessandro et al. 2018). According to Wu et al. (2015), implementing a recursive non-stop development process like the Plan Inspires, Do, Check, and Act (PDCA) model will neither eliminate or lessen the possibility of errors and unfavorable consequences in healthcare systems.
Risk analysis includes both inherent and residual methodologies, taking into account the probability and impact of risks. The risk manager discovers and evaluates various risk responses, such as evasion, adoption, minimization, and transfer, in accordance with the company’s risk tolerance. Decision-makers can decide which dangers to manage based on their risk rankings. (Abor and Abor, 2021; Strametz, 2017). To address enterprise risk management (ERM), risk management in healthcare is transitioning from a reactive to a proactive strategy, including predictive modeling and risk classification (Park and Sharp, 2019).
The risk management system contains a reporting structure for identifying, reporting, tracking, and trending event patterns that may result in negative patient outcomes or harm to the organization’s people, assets, or property (Abor & Abor, 2021). Regular safety training and orientation, as well as employee involvement, are critical components of healthcare risk management. A formal documented risk reporting and management tools system is also required. This document describes how risks are addressed, as well as response timeframes, the chain of command, and records of related operations (Abor & Bonsu, 2020; Kaya et al., 2016).
A effective risk management program has several benefits, including assuring compliance with safety standards, discovering weaknesses before an adverse event, limiting loss after an incident, and upgrading safety to enhance patient outcomes and reduce adverse event frequency, kind, and severity. (Abor and Abor, 2021).
Alessandro et al. (2018) recognized education and training as critical risk management practices in healthcare, whereas Pascarella et al. (2021) stressed the importance of a systematic risk management framework, which includes the use of a risk matrix, in healthcare organizations.
Ferdosi et al. (2020) advocated that healthcare organizations use a variety of risk management approaches and technologies tailored to their specific needs. However, there is a dearth of research on the impact of risk management on workers’ safety in Nigerian healthcare organizations. Therefore, this study aims to appraise the assessment of risk management in healthcare service in Nigeria, by assessing risk management practices, the influence of risk management on workers’ safety, and the challenges associated with effective risk management implementation.
1.2 Statement of the Problem
In the complex and dynamic landscape of healthcare, patient safety remains a paramount concern. Despite significant attempts to incorporate risk management measures, healthcare businesses continue to encounter issues such as medical errors, adverse events, and poor patient outcomes. These difficulties underscore the necessity for a thorough assessment into the efficacy and limitations of existing risk management systems used by healthcare institutions. Furthermore, the changing nature of healthcare delivery, such as technological improvements, shifting patient demographics, and global health crises, presents new risks and uncertainties that require a rethinking of current risk management techniques.
As a result, there is a critical need to review the alignment of risk management strategies with new healthcare trends, as well as identify potential gaps and possibilities for improvement. The risk management tactics used by a healthcare facility to provide quality service to patients or clients have a significant impact on the service experience. In an ideal environment where risk management measures are followed, service must be demonstrated by proper patient data capture and recovery, quick solutions and feedback, staff self-confidence and technical competence, friendly attention, and facility management. To provide outstanding service, a health centre would need to implement some risk management strategies as well as quality management systems.
However, problems such as unexpected deaths, failure to detect or manage disease, surgical errors, or accidents do occur in most hospitals across the country. Clients in OPDs face additional issues such as excessive wait times, insufficient health workers, uneven administrative procedures, unsuitable seating arrangements, and unsanitary surroundings. All of these have a negative impact on the provider’s ability to give medical care. This terrible occurrence raises the question of whether there are risk management procedures in Nigerian healthcare services.